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Trends That Matter for Copay Accumulator Programs

Posted by Leslie Small on Apr 22, 2021

Thanks to recent regulatory moves and the increasing prevalence of copay accumulator/maximizer programs, the tactics that payers use to counter drug manufacturer copay assistance continue to be a controversial topic in the health care sector, AIS Health reported.

Copay accumulators work by preventing any monetary assistance that pharmaceutical companies offer commercially insured patients from counting toward their deductible or out-of-pocket maximum. Their close cousin, copay maximizers, take the total amount of a manufacturer's copay offset program and divide it by 12, and that amount becomes the new monthly copayment for all patients on any given drug over the course of a year.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: UnitedHealth Reports 'Good Start to the Year,' But Expects COVID Earnings Hit Later

Posted by Leslie Small on Apr 22, 2021

UnitedHealth Group began the first quarter of 2021 on a high note, reporting earnings per share (EPS) and a medical loss ratio (MLR) that both beat the Wall Street consensus estimate and saying it expects to achieve greater full-year earnings than it previously estimated, AIS Health reported. However, executives warned that the majority of the unfavorable COVID-19-related impact they're expecting will transpire in the second half of the year.

UnitedHealth expects roughly 70% of the predicted COVID-related $1.80 EPS hit to occur in the back half of the year, Chief Financial Officer John Rex said during an April 15 conference call to discuss the company’s financial results. He said that projection is based on UnitedHealth's prediction that as the year wears on and vaccination rates rise, people will increasingly be able to access higher-acuity, previously deferred care.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Uber Partnership With ScriptDrop Heats Up Rx Delivery Space

Posted by Jane Anderson on Apr 20, 2021

Uber, seeking to expand its prescription delivery business nationwide, has inked a deal with pharmacy home delivery start-up ScriptDrop that makes Uber the default delivery app for a network of grocery store and independent pharmacies that spans 37 states, AIS Health reported.

The partnership, which is just one of many corporate moves in the pharmacy delivery space, positions Uber to take advantage of the vastly increased consumer demand for home delivery services sparked by the pandemic.

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Topics: Industry Trends, Data & Analytics

Perspectives on ACA Subsidy Expansion

Posted by Leslie Small on Apr 15, 2021

For an individual health insurance market that is already hitting its stride, the new pandemic relief legislation's expansion of Affordable Care Act (ACA) subsidies is yet another positive catalyst that should make the exchanges more attractive to insurers and customers alike, experts tell AIS Health.

Under the American Rescue Plan, which President Joe Biden signed into law on March 11, individuals who already qualified for premium tax credits under the ACA will see more generous financial aid. In addition, people who earn more than 400% of the federal poverty level (FPL) will be eligible for reduced premiums for the first time thanks to a provision that caps marketplace premiums at 8.5% of all enrollees' income.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Evernorth Drug Trend Report Highlights Pandemic's Impact on Utilization

Posted by Leslie Small on Apr 13, 2021

In the 2020 Drug Trend Report recently released by Evernorth, the Cigna Corp. division added yet another chapter to the growing volume of data detailing the profound effects that the COVID-19 pandemic has had on health care, AIS health reported.

On the one hand, the massive amount of deferred routine and elective health care utilization had a dampening effect on the number of new medication users that Evernorth — which houses the PBM Express Scripts — recorded in 2020. New users of asthma/COPD medications dropped the most, by 7.1% year over year, likely reflecting the avoidance of clinical settings among a group that is at particular risk of contracting severe COVID-19.

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Topics: Industry Trends, Data & Analytics

Trends That Matter for Partial Orphan Drugs

Posted by Peter Johnson on Apr 8, 2021

A new study published in Health Affairs found that spending in the orphan drug category is overwhelmingly concentrated on so-called partial orphan drugs, which have both orphan and nonorphan indications. The study affirms growing concerns across the health care industry that drugmakers are misusing the orphan drug designation and introducing unwarranted cost into the drug channel, AIS Health reported.

The Orphan Drug Act of 1983 covers diseases that affect fewer than 200,000 people in the U.S., plus diseases that affect more than 200,000 people but are so expensive to treat that companies developing and marketing such therapies are not expected to recover their costs. With the designation, the FDA grants drugmakers expanded intellectual property and commercial rights intended to offset these steep costs.
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Topics: Industry Trends, Market Access, Product Release, Data & Analytics

Radar On Market Access: Interoperability Mandate Could Be an Opportunity for Payers

Posted by Peter Johnson on Apr 8, 2021

Payers should look at the looming interoperability mandate as a chance to gain a lasting advantage over their competitors, according to two health care information technology (IT) experts.

In a March 26 webinar hosted by America's Health Insurance Plans (AHIP), IBM Vice President Michael Curry of Watson Health and Jeff Rivkin, research director for payer IT strategies at IDC Insights, said payers should do more than meet the minimum interoperability standards, AIS Health reported.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Study Highlights Promise of Bundled Payments in Employer Plans

Posted by Jane Anderson on Apr 6, 2021

A bundled payment program run by San Francisco-based digital health company Carrum Health resulted in an average per-episode savings of more than $16,000 per orthopedic or surgical procedure, a recent RAND Corp. analysis found.

Counting both procedures reimbursed under the bundled payment program and procedures reimbursed outside the program, per-episode costs for the three procedures studied — spinal fusion, major joint replacement and bariatric surgery — were 10.7% lower overall, on average, than costs for comparable procedures prior to implementation of the program. That added up to a total savings of $4,229 per episode, the study found.

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Topics: Industry Trends, Data & Analytics, Payer

Perspectives on Cigna's MDLive Deal

Posted by Peter Johnson on Apr 1, 2021

Health insurers have begun to consolidate their position in the telehealth market, as indicated by a recent move by Cigna Corp. to acquire MDLive Inc. Meanwhile, lawmakers are beginning to consider the future of telehealth regulation and payment, AIS Health reported.

Cigna's Evernorth health services arm announced on Feb. 26 that it had reached an agreement with MDLive to acquire the virtual care provider, according to MDLive's website. MDLive has been available in-network as a primary care option to all members of Cigna's commercial plans since January 2020.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: PBM Regulation, Rebate Rule Are High on Legislative Agenda

Posted by Peter Johnson on Apr 1, 2021

As a new bill introduced by Sen. Bernie Sanders (I-VT) indicates, Congress is once again looking seriously at tackling drug pricing reform. D.C. insiders say that Democrats could pursue big changes to PBM regulation and Medicare's ability to negotiate drug prices, AIS Health reported.

Also, Congress could repeal the Trump administration’s so-called "rebate rule," which would have removed safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs and Medicare Part D plans.

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Topics: Industry Trends, Market Access, Payer